Do Manipulating Medics Tell the Truth?
How often do we see and hear criticisms of the treatment that chiropractors render to their patients, whether it be for treating disk problems, or administering to children with asthma or ear aches?
In the major medical text, Spinal Manipulation,1 authored by the past president of the North American Academy of Manipulative Medicine, both an MD and a PT defend manipulation against much of the common criticism leveled at it. While the text generally ignores chiropractic research and is strongly biased towards osteopathic care, it still speaks to a number of issues that DCs will find interesting:
Palpatory Skill
"One of the difficulties which people have in understanding and applying techniques of manual medicine is that both diagnosis and treatment require a degree of palpatory skill that is different from, and in some ways greater than, that used in other branches of medicine. The difficulty can be likened to that of an untrained person trying to read the dots of Braille writing. To those who have not practiced, such as the authors, this seems to be impossible but, as is well known, can be learned."Even with the obvious differences between "medical manipulation" and the chiropractic adjustment, a "double standard" exists, inviting criticism of chiropractic care.Manipulating Children
"In schoolchildren's orthopaedic clinics one of the authors saw many primary school children with symptoms arising from lumbar dysfunctions. In most of these a parent would remember an injury when specifically asked, but the history had to be searched for before it was mentioned. Unless they are treated, by the time these children have reached adulthood, the compensatory asymmetries will almost certainly have become fixed and themselves require treatment."
Disc Protrusion
"There is no doubt that surgery is occasionally the only satisfactory treatment for those with unequivocal signs of protrusion, and the more so with extrusion of disc material. There is also ample evidence in the experience of most manual practitioners to show that, even in the presence of such unequivocal evidence, relief may be obtained by conservative measures including manual intervention."
Epidural Injections
"Caudal epidural injections can be helpful, either by themselves or in the expectation that they will allow a manipulation to be performed by reducing the muscle spasms. In the author's experience they become less necessary as the palpatory skill and general ability of the operator increases."
Manipulation under Anesthetic
"During his postgraduate training, the author referred to above worked under an orthopaedic surgeon who used manipulation under anesthetic with many good results; he never allowed forced flexion under anesthetic and never had an incident with this treatment. The same author has had similar experiences using manipulation under anesthetic but since he has learned to be specific, he has ceased to use general anesthesia which can actually be a hindrance because localisation becomes more difficult."
The Chiropractic Profession
"The chiropractic profession is probably one of the most rapidly growing in the health field, and indeed, if a layman thinks that manipulation is required, it is a chiropractor that he is more likely to consult. There are too few osteopaths to meet the demand. One would not ordinarily even seek the service from a medical practitioner, if one was aware what was needed was manipulation. The chiropractors, however, labour under a burden: if one trains in chiropractic, and a satisfactory level is simply not attainable by that particular individual, he has no alternative in the profession but to manipulate, however poorly, unless he is going to abandon the time and effort he has invested in qualifying. Chiropractors offer an important service and more medical physicians are sending their patients to chiropractors; there is less undignified antagonism and more recognition of a field in which medicine today has little to offer."
Reference
1. Bourdillon JE, Day EA, Bookhout MR: Spinal Manipulation, 5th edition. Oxford, England, Butterworth-Heinemann Ltd, 1992.
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